Table 2 Characterization of included studies that did not use the initial definition of HCAI[3] by focus of infection
Study, year of publication | Study design | HCAI criteria | MDR* organisms | Risk of bias | ||
|---|---|---|---|---|---|---|
A. Bloodstream infections | ||||||
Siegman-Igra et al., 2002 [7] | Prospective, single center, 1,028 infections in 912 patients; Israel, 1 year | 1. Discharge from hospital 2 to 30 days previously | CAI | HCAI | HAI | Moderate |
2. Nursing-home acquired | 8 (2) | 24 (10) | 71 (17) | |||
3. Patients with long-term intravenous devices, for hemodialysis, chemotherapy or parenteral nutrition | ||||||
4. Chronic hemodialysis | ||||||
5. Invasive procedure previously or at hospital admission | ||||||
Shorr et al., 2006 [11] | Retrospective, multicenter, 6,697 patients; USA, 2 years | 1. Prior hospitalization within 30 days | CAI | HCAI | HAI | Low |
2. Transfer from another healthcare facility | 152 (2) | 397 (11) | 62 (13) | |||
3. Chronic hemodialysis | ||||||
4. Immunosuppression medication or metastatic cancer | ||||||
Kao et al., 2011 [30] | Prospective, single center, 890 infections in 831 patients older than 14 years; Taiwan, 1 year | 1. Hospitalized for 2 or more days in the previous 90 days | CAI | HCAI | HAI | High |
2. Resided in a nursing home | 11 (2) | 41 (16) | 42 (41) | |||
3. Hemodialysis, intravenous chemotherapy or invasive procedures in the previous 90 days | ||||||
Kollef et al., 2011 [12] | Prospective, multicenter, 1,143 patients; USA, 1 year | 1. Prior hospitalization within 6 months | CAI | HCAI | Low | |
2. Admission from a skilled nursing facility | 79 (19) | 242 (33) | ||||
3. Hemodialysis | ||||||
4. Immunosuppression | ||||||
Al-Hasan et al., 2012 [31] | Retrospective, multicenter, 733 episodes of gram negative bacteremia; excludes polymicrobial, nosocomial and recurrent episodes; USA, 10 years | 1. Hospitalized for 2 or more days in the previous 90 days | CAI | HCAI | Moderate | |
2. Residents in a nursing home or long-term care facility | 12 | 28 (7) | ||||
3. Received intravenous therapy including ATB and chemotherapy | ||||||
4. Hemodialysis in the previous 30 days | ||||||
Lenz et al., 2012 [32] | Retrospective, multicenter, 7,712 patients; only samples obtained in the first 5 days of hospital admission; Canada, 8 years | 1. Hospitalized for 2 or more days in the previous 90 days | CAI | HCAI | HAI | Low |
2. Nursing home or long term-care facility | 59 (2) | 158 (6) | 202 (9) | |||
3. Visit a hospital, clinic or emergency department within the prior 5 to 30 days | ||||||
4. Hemodialysis | ||||||
5. Active cancer | ||||||
B. Pneumonia | ||||||
Kollef et al., 2006 [13] | Retrospective, multicenter, 4,543 patients with positive cultures within 5 days of hospital admission, USA, 2 years | 1. Prior hospitalization within 30 days | CAI | HCAI | HAI | High |
2. Admission from another care facility | 624 (28) | 537 (54) | 362 (43) | |||
3. Receiving long-term hemodialysis | ||||||
Micek et al., 2007 [33] | Retrospective, single center, 639 patients older than 16 years with positive cultures, Spain, 2 years | 1. Hospitalization in the past 12 months | CAI | HCAI | Low | |
2. Resident in a nursing home or long-term care facility or rehabilitation hospital | 35 (17) | 242 (56) | ||||
3. Outpatient hemodialysis, peritoneal dialysis or infusion therapies requiring regular visits to a clinic | ||||||
4. Immunosuppression | ||||||
Schreiber et al., 2010 [34] | Retrospective, single center study, 190 patients needing mechanical ventilation more than 24 hours after hospital admission, patients without evidence of bacterial infection and patients transferred from other hospitals were excluded, USA, 4 years | 1. Recent hospitalization (90 days) | CAI | HCAI | Low | |
2. Admission from a long-term facility | 17 (18) | 48 (48) | ||||
3. Recent treatment with broad spectrum antibiotics (30 days) | ||||||
4. Chronic hemodialysis | ||||||
5. Wound care | ||||||
6. Immunosuppression | ||||||
Grenier et al., 2011 [14] | Retrospective, single center study, 3,295 patients, those transferred from other hospitals or discharged from an acute care facility within 14 days were excluded, Canada, 12 years | 1. Hospitalization in the past 90 days, but not in the last 14 days | CAI | HCAI | Low | |
2. Resident of a nursing home or long-term care facility | 42 (4) | 21 (10) | ||||
3. Outpatient intravenous therapy or cancer therapy within the previous month | ||||||
4. Long term hemodialysis | ||||||
Guimarães et al., 2011 [35] | Retrospective, single center study, 197 patients, Portugal, 1 year | 1. Hospitalization for 2 days or more in the preceding 90 days | CAI | HCAI | High | |
2. Resident of a nursing home or extended-care facility | 2 (18) | 9 (82) | ||||
3. Intravenous antibiotic therapy or chemotherapy within 30 days | ||||||
4. Chronic dialysis within 30 days | ||||||
5. Home wound care | ||||||
6. Family member with multi-drug resistant pathogen | ||||||
Chalmers et al., 2011 [36] | Prospective, single center, 1,348 patients; Scotland, 4 years and 5 months | 1. Hospitalization for 2 days or more in the preceding 90 days | CAI | HCAI | High | |
2. Resident of a nursing home or extended-care facility | 3 (1) | 5 (6) | ||||
3. Home infusion therapy (including antibiotics and long-indwelling devices as catheters) | ||||||
4. Chronic dialysis within 30 days | ||||||
5. Home wound care | ||||||
6. Family member with multi-drug resistant pathogen | ||||||
Tasbakan et al., 2011 [37] | Retrospective, single center study, 187 patients, Turkey, 1 year | 1. Hospitalization for 2 days or more in the preceding 90 days | CAI | HCAI | Low | |
2. Resident of a nursing home or extended-care facility | 1 (13) | 17 (44) | ||||
3. Home infusion therapy (including antibiotics) | ||||||
4. Chronic dialysis within 30 days | ||||||
5. Home wound care | ||||||
6. Family member with multi-drug resistant pathogen | ||||||
Ishida et al., 2012 [38] | Retrospective, single center, 893 patients; Japan, 3 years | 1. Discharged from a hospital in the preceding 90 days | CAI | HCAI | Low | |
2. Resident in a nursing home or extended-care ward | 6 (3) | 37 (21) | ||||
3. A patient who regularly requires vascular access for dialysis, antimicrobial treatment, chemotherapy or immunosuppressive therapy in an outpatient setting | ||||||
4. Elderly or handicap who needs long-term care with an ECOG of 3 or 4 | ||||||
Miyashita et al., 2012 [39] | Prospective, multicenter, 1,385 patients; CAI and HCAI were considered until 72 h after hospital admission, Japan, 6 years | 1. Discharged from a hospital in the preceding 90 days | CAI | HCAI | High | |
2. Resident in a long-term nursing home setting or healthcare home | 21 (4) | 78 (20) | ||||
3. Continuous receiving endovascular therapy in an ambulatory setting (including dialysis, antibiotics, anticancer drugs and immunosuppression) | ||||||
4. Elderly persons or physical disable persons who need healthcare | ||||||
Wu et al., 2012 [40] | Retrospective, multicenter study, 1,646 patients, those with pneumonia developing 2 days after admission or less than 14 days after the last hospitalization, with lung cancer obstructive pneumonia or HIV positive status with CD4+ t <200 were excluded, Taiwan,1 year | 1. Undergoing repeated hospitalization within 90 days before | CAI | HCAI | Low | |
2. Residing in a nursing home | 122 (15) | 169 (28) | ||||
3. Receiving radiation therapy or chemotherapy at an outpatient clinic | ||||||
4. Received regular dialysis at an out patients clinic | ||||||
Sugisaki et al., 2012 [41] | Retrospective, single center study, 526 patients, Japan, 4 years | 1. Hospitalization for 2 days or more in the preceding 90 days | CAI | HCAI | Low | |
2. Resident of a nursing home or extended-care facility | 50 (15) | 72 (40) | ||||
3. Home infusion therapy (including antibiotics and long indwelling devices as catheters) | ||||||
4. Chronic dialysis within 30 days | ||||||
5. Home wound care | ||||||
6. Family member with multi-drug resistant pathogen | ||||||
Giannella et al., 2012 [42] | Prospective, multicenter, 1,002 patients older than 16 years admitted into internal medicine departments, Spain, 2 weeks | 1. Hospitalization in the past 180 days | CAI | HCAI | HAI | Low |
2. Resident in a nursing home or extended-care facility | 6 (4) | 19 (29) | 11 (52) | |||
3. Attending a hospital regularly because of chronic underlying disease | ||||||
4. Undergoing hemodialysis | ||||||
5. Wound care or specialized nursing care in the past 30 days | ||||||
6. Chemotherapy in the past 30 days | ||||||
7. Surgery in the past 180 days | ||||||
C. Other foci | ||||||
Swenson et al., 2009 [43] | Retrospective, single center study, 2,049 intra-abdominal infections; Canada, 10 year | 1. Patients with a story of any hospitalization in the previous 30 days | CAI | HCAI | High | |
2. Resident of a nursing home or rehabilitation facility in the previous 30 days | 27 (7) | 221 (28) | ||||
Merli et al., 2010 [44] | Prospective, single center study, in 54 patients with cirrhosis, patients with HIV infection, under high dose of corticosteroid treatment or immunosuppressive therapy were excluded, Italy, 9 months | 1. Hospitalization for 2 or more days or had undergone surgery during the preceding 180 days | CAI | HCAI | HAI | Low |
2. Resident of a nursing home or long-term care facility | 2 (50) | 9 (82) | 5 (45) | |||
3. Attended a hospital or hemodialysis clinic or received intravenous chemotherapy in the 30 days before | ||||||
Ha et al., 2011 [45] | Retrospective, single center study, in 319 patients with urinary infection; Korea, 1 year | 1. Hospitalization for 2 or more days in an acute care hospital in the preceding 90 days | CAI | HCAI | Low | |
2. Resident of a nursing home or long-term care facility | 1 (1) | 28 (14) | ||||
3. Received intravenous therapy, wound care or specialized nursing care at home in the previous 30 days | ||||||
4. Attended a hospital or hemodialysis clinic or received intravenous chemotherapy in the 30 days before | ||||||
5. Received an invasive procedure, urological surgery or urethral catheterization in the previous 7 days | ||||||
Sy et al., 2012 [46] | Retrospective, multicenter study, in 1,536 patients with endocarditis; patients transferred from another hospital, recurrent admissions or day-stay admissions were excluded, Australia, 6 years | 1. Hospitalization for 2 days or more in the preceding 90 days | HCAI | Non-HCAI | High | |
2. Resident of a nursing home or in a long-term facility | 40 (26) | 61 (18) | ||||
3. Attended a hemodialysis clinic or received intravenous therapy in the 30 days before | ||||||